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1. Alberto Giubilini1,2, 2. Francesca Minerva3 + Author Affiliations 1. Department of Philosophy, University of Milan, Milan, Italy 2. Centre for Human Bioethics, Monash University, Melbourne, Victoria, Australia 3. Centre for Applied Philosophy and Public Ethics, University of Melbourne, Melbourne, Victoria, Australia 1. Correspondence to Dr Francesca Minerva, CAPPE, University of Melbourne, Melbourne, VIC 3010, Australia; francesca.minerva@unimelb.edu.au 1. Contributors AG and FM contributed equally to the manuscript.
Received 25 November 2011 Revised 26 January 2012 Accepted 27 January 2012 Published Online First 23 February 2012
Abstract
Abortion is largely accepted even for reasons that do not have anything to do with the fetus' health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call after-birth abortion (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.
Introduction
Severe abnormalities of the fetus and risks for the physical and/or psychological health of the woman are often cited as valid reasons for abortion. Sometimes the two reasons are connected, such as when a woman claims that a disabled child would represent a risk to her mental health. However, having a child can itself be an unbearable burden for the psychological health of the woman or for her already existing children,1 regardless of the condition of the fetus. This could happen in the case of a woman who loses her partner after she finds out that she is pregnant and therefore feels she will not be able to take care of the possible child by herself.
A serious philosophical problem arises when the same conditions that would have justified abortion become known after birth. In such cases, we need to assess facts in order to decide whether the same arguments that apply to killing a human fetus can also be consistently applied to killing a newborn human. Such an issue arises, for example, when an abnormality has not been detected during pregnancy or occurs during delivery. Perinatal asphyxia, for instance, may cause severe brain damage and result in severe mental and/or physical impairments comparable with those for which a woman could request an abortion. Moreover, abnormalities are not always, or cannot always be, diagnosed through prenatal screening even if they have a genetic origin. This is more likely to happen when the disease is not hereditary but is the result of genetic mutations occurring in the gametes of a healthy parent. One example is the case of Treacher-Collins syndrome (TCS), a condition that affects 1 in every 10000 births causing facial deformity and related physiological failures, in particular potentially lifethreatening respiratory problems. Usually those affected by TCS are not mentally impaired and they are therefore fully aware of their condition, of being different from other people and of all the problems their pathology entails. Many parents would choose to have an abortion if they find out, through genetic prenatal testing, that their fetus is affected by TCS. However, genetic prenatal tests for TCS are usually taken only if there is a family history of the disease. Sometimes, though, the disease is caused by a gene mutation that intervenes in the gametes of a healthy member of the couple. Moreover, tests for TCS are quite expensive and it takes several weeks to get the result. Considering that it is a very rare pathology, we can understand why women are not usually tested for this disorder. However, such rare and severe pathologies are not the only ones that are likely to remain undetected until delivery; even more common congenital diseases that women are usually tested for could fail to be detected. An examination of 18 European registries reveals that between 2005 and 2009 only the 64% of Down's syndrome cases were diagnosed through prenatal testing.2 This percentage indicates that, considering only the European areas under examination, about 1700 infants were born with Down's syndrome without parents being aware of it before birth. Once these children are born, there is no choice for the parents but to keep the child, which sometimes is exactly what they would not have done if the disease had been diagnosed before birth.
Although it is reasonable to predict that living with a very severe condition is against the best interest of the newborn, it is hard to find definitive arguments to the effect that life with certain pathologies is not worth living, even when those pathologies would constitute acceptable reasons for abortion. It might be maintained that even allowing for the more optimistic assessments of the potential of Down's syndrome children, this potential cannot be said to be equal to that of a normal child.3 But, in fact, people with Down's syndrome, as well as people affected by many other severe disabilities, are often reported to be happy.5 Nonetheless, to bring up such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care. On these grounds, the fact that a fetus has the potential to become a person who will have an (at least) acceptable life is no reason for prohibiting abortion. Therefore, we argue that, when circumstances occur after birth such that they would have justified abortion, what we call after-birth abortion should be permissible. In spite of the oxymoron in the expression, we propose to call this practice after-birth abortion, rather than infanticide, to emphasise that the moral status of the individual killed is comparable with that of a fetus (on which abortions in the traditional sense are performed) rather than to that of a child. Therefore, we claim that killing a newborn could be ethically permissible in all the circumstances where abortion would be. Such circumstances include cases where the newborn has the potential to have an (at least) acceptable life, but the well-being of the family is at risk. Accordingly, a second terminological specification is that we call such a practice after-birth abortion rather than euthanasia because the best interest of the one who dies is not necessarily the primary criterion for the choice, contrary to what happens in the case of euthanasia. Failing to bring a new person into existence cannot be compared with the wrong caused by procuring the death of an existing person. The reason is that, unlike the case of death of an existing person, failing to bring a new person into existence does not prevent anyone from accomplishing any of her future aims. However, this consideration entails a much stronger idea than the one according to which severely handicapped children should be euthanised. If the death of a newborn is not wrongful to her on the grounds that she cannot have formed any aim that she is prevented from accomplishing, then it should also be permissible to practise an after-birth abortion on a healthy newborn too, given that she has not formed any aim yet. There are two reasons which, taken together, justify this claim: 1. The moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a person in a morally relevant sense. 2. It is not possible to damage a newborn by preventing her from developing the potentiality to become a person in the morally relevant sense. We are going to justify these two points in the following two sections.
to cure one of the embryos the woman is given the option to use the other twin to develop a therapy. If she agrees, she attributes to the first embryo the status of future child and to the other one the status of a mere means to cure the future child. However, the different moral status does not spring from the fact that the first one is a person and the other is not, which would be nonsense, given that they are identical. Rather, the different moral statuses only depends on the particular value the woman projects on them. However, such a projection is exactly what does not occur when a newborn becomes a burden to its family.
people's well-being could be threatened by the new (even if healthy) child requiring energy, money and care which the family might happen to be in short supply of. Sometimes this situation can be prevented through an abortion, but in some other cases this is not possible. In these cases, since non-persons have no moral rights to life, there are no reasons for banning after-birth abortions. We might still have moral duties towards future generations in spite of these future people not existing yet. But because we take it for granted that such people will exist (whoever they will be), we must treat them as actual persons of the future. This argument, however, does not apply to this particular newborn or infant, because we are not justified in taking it for granted that she will exist as a person in the future. Whether she will exist is exactly what our choice is about.
Conclusions
If criteria such as the costs (social, psychological, economic) for the potential parents are good enough reasons for having an abortion even when the fetus is healthy, if the moral
status of the newborn is the same as that of the infant and if neither has any moral value by virtue of being a potential person, then the same reasons which justify abortion should also justify the killing of the potential person when it is at the stage of a newborn. Two considerations need to be added. First, we do not put forward any claim about the moment at which after-birth abortion would no longer be permissible, and we do not think that in fact more than a few days would be necessary for doctors to detect any abnormality in the child. In cases where the after-birth abortion were requested for non-medical reasons, we do not suggest any threshold, as it depends on the neurological development of newborns, which is something neurologists and psychologists would be able to assess. Second, we do not claim that after-birth abortions are good alternatives to abortion. Abortions at an early stage are the best option, for both psychological and physical reasons. However, if a disease has not been detected during the pregnancy, if something went wrong during the delivery, or if economical, social or psychological circumstances change such that taking care of the offspring becomes an unbearable burden on someone, then people should be given the chance of not being forced to do something they cannot afford.
Acknowledgments
We would like to thank Professor Sergio Bartolommei, University of Pisa, who read an early draft of this paper and gave us very helpful comments. The responsibility for the content remains with the authors.
Footnotes
Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
References
1. Abortion Act. London: Stationery Office, 1967. 2. European Surveillance of Congenital Anomalies. EUROCAT Database. http://www.eurocatnetwork.eu/PRENATALSCREENINGAndDIAGNOSIS/Prenatal DetectionRates (accessed 11 Nov 2011). (data uploaded 27/10/2011). 3. 1. Kuhse H,
2. Singer P . Should the Baby live? The Problem of Handicapped Infants. Oxford: Oxford University Press, 1985:143. 4. 1. Verhagen E, 2. Sauer P . The groningen protocoleuthanasia in severely Ill newborns. N Engl J Med 2005;10:95962. 5. 1. Alderson P . Down's Syndrome: cost, quality and the value of life. Soc Sci Med 2001;5:62738. 6. 1. Tooley M . Abortion and infanticide. Philos Public Aff 1972;1:3765. 7. 1. Hare RM 2. Hare RM . Abortion and the golden rule. In: Hare RM, ed. Essays on Bioethics. New York: Oxford University Press, 1993:14767. 8. 1. Hare RM 2. Hare RM . A Kantian approach to abortion. In: Hare RM, ed. Essays on Bioethics. New York: Oxford University Press, 1993:16884. 9. 1. Hare RM 2. Hare RM . The abnormal child. Moral dilemmas of doctors and parents. In: Hare RM, ed. Essays on Bioethics. New York: Oxford University Press, 1993:18591. 10. 1. Condon J
. Psychological disability in women who relinquish a baby for adoption. Med J Aust 1986;144:11719. [Medline][Web of Science] 11. 1. Robinson E . Grief associated with the loss of children to adoption. In: Separation, reunion, reconciliation: Proceedings from The Sixth Australian Conference on Adoption. Stones Corner, Brisbane: Benson J, for Committee of the Conference, 1997:268 93, 278.